NHS

Hospitals are forbidding doctors from sitting on the bed, in the name of infection control. But no link has been made between sitting on the bed and increased rates of infection and as Dr Heath concludes:

“can we not campaign for home within hospital and encourageflowers and sitting on the bed and every other informality,unless there is robust evidence to deter us? ‘Do not sit onthe bed’ and ‘No flowers’ are injunctions that are all too similarto ‘Do not walk on the grass’ and ‘No ball games’ rules thatmostly diminish the joys of life rather than enhance them, andsuch rules, unless absolutely necessary, have no place in hospitals,where joy is too often in short supply.”

Having seen many ward rounds conducted from a standing position at the end of the bed, I have to agree.

The politician in the internet chat room: Gordon Brown made a few interesting pledges the other day in a Mother’s day web chat on the forum Netmums.

“So this week, for example, Andy Burnham will be setting out new plans to really change and reform maternity services. Over the next few years we want to see a legal right for mums to choose where they give birth, including home births for anyone who wants one. And we want to see services changed so that not just mums but dads can have a bed if they need to stay in hospital overnight after the birth of their baby. We have also set a goal to recruit an extra 4,000 midwives by 2012.”

A legal right to give birth where you want? Is this really a good idea? Starting a discussion about where best to book in to doesn’t seem to get off on the right foot when a clinical decision has been taken by a politician and there is a legal ultimatum.

I am confused. The Robert Francis inquiry is a the response to the Healthcare Commission’s investigation into the higher than expected mortality rate at the Mid Staffordshire NHS Foundation Trust.

The enquiry says “many staff” expressed concerns, but were “ignored”. Nurses complained there were not enough beds to cope with the demands placed on the service, and that they were expected to deal with a workload far above what could be safely managed.

Pressures to meet waiting time targets compromised care – for example patients were moved out of A&E regardless of their clinical state and how much monitoring they needed.

There were not enough senior and skilled nurses.

Wards were made more mixed to contain more different types of cases, despite objections from clinical staff that it would compromise care.

Trained staff numbers were reduced in ward reorganisations which went ahead despite opposition from clinical staff.

Why were the savings being made? The hospital was in debt, and this is what drove staff cuts.

Alan Johnson, then health secretary, has said there was a ”a complete failure of management to address serious problems and monitor performance”. But management had in fact been doing an awful lot of what they had been told to do: sort out the financial problems, meet the targets.

We are now coming round to thinking that it isn’t just individual mistakes that should be seen as problems, but the system, which allowed them to occur.

Blaming the managers is an easy option. Isn’t it the case that the system that managed this Trust – the political structure that told it what ‘good outcomes’ were – is the one to blame?

On February 22nd the UK government Science and Technology Committee published Evidence Check 2: Homeopathy and concluded that “the NHS should cease funding homeopathy”. Hurrah!

It also noted that ”the Medicines and Healthcare products Regulatory Agency (MHRA) should not allow homeopathic product labels to make medical claims without evidence of efficacy. As they are not medicines, homeopathic products should no longer be licensed by the MHRA.” Hurrah again.

But this is the really really interesting bit. “In the Committee’s view,
homeopathy is a placebo treatment and the government should have a policy on prescribing placebos.”. They go on to say that placebos involve deception, and are not consistent with informed consent.

I am ashamed at how late I run, some days, at work. I have gaps built in to my appointment times for catch up (resulting in a longer overall clinic) but it is never enough. Sometimes I try and reflect on what I could do faster, but I can’t usually come up with much that I could myself control and that I think it’d be a good idea to do.

Various studies have suggested that the average number of items a GP deals with in one appointment is 3. A ten minute appointment, then, is rather stretched.

So last week I had several emails, and then saw several adverts/advertorial, for a device which is being sold in Boots, called ‘Breast Light’. It is almost 90 UK pounds, and it is being given a prominent position in my local store. The website for it claims it is ‘for earlier detection’.

I asked the pharmacist why Boots was selling it. She said it was for patient choice, and it was a useful thing for women to have. I asked her what the evidence was that it worked. She told me to look at the website. Hmm.

The NHS ”Distinction Award” Scheme was set up as a way to reward hospital consultants for being extra-good.

If they wrote books, set up services, pioneered, discovered or whatever, then there was the possibility, after the decision of a closed-door committee, of an award (at levels 1-8, then the shiny upper echelons of bronze, silver, gold and platinum).

At the top end of the scale (and I should say that these are the minority of awards) they are worth just above £70,000. That’s on top of basic wages.

Part of UK NHS development has been to make some nurses specialists in their area. Some aspects of this are not new – if you keep people learning and involved in a certain area – diabetes, say, or asthma – they are going to get very familiar with management of that particular condition.

The NHS and Department of Health, though, have moved things further yet – for example, by allowing nurses to prescribe any medicine after a few weeks training. Not everyone has “done the course” however, or wants to sign their name – which means that phone calls are not unusual from, say, the pain nurse, the respiratory nurse, or the terminal care nurse asking for a patient to be given whatever drug.

Cuts in NHS spending are looming. So we would want to be sure that the money in study budgets is being wisely and carefully spent, and with an eye on the evidence.

This course - Core Skills in Creating Excellence in Patient Experience – is not the most expensive of its type but look at how many kinds of staff it is aimed at - all administrators and lots of nurses. It could give Martin Lukes a run for his money for gobbledesense: “Lead the creation of a truly customer-centric culture of excellence … this course, designed for those taking the lead, comprehensively covers developing a patient experience excellence strategy and implementing it throughout a team, department or even a whole Trust.” All in just one day!

Thank you for reading, responding and emailing to posts and columns during 2009. Much appreciated, even if challenging. Further projects for 2010 will include disclosure into what quango took 6 months to reply to a basic query about regulation of non-NHS clinics – and there will also be forays into evidence based cooking.

Clive Cookson has been a science journalist for the whole of his working life. He joined the FT in 1987. Clive, the FT's science editor, picks out the research that everyone should know about. He also discusses key policy issues, from R&D funding to science education.

Andrew Jack is pharmaceuticals correspondent, covering the industry and public health issues. He has been a journalist with the FT for 19 years, based in London, Paris and Moscow